Culturally-Appropriate Health Education Improves Clinical & Behavioral Outcomes.

Results from a study presented at the Centers for Disease Control and Prevention Diabetes Translation Conference indicate that a patient-centered health education program has a positive impact on reducing the health disparities and improving outcomes among Hispanic patients with diabetes and depression. Study results show an improvement in diabetes self-management skills such as daily glucose monitoring and a decrease in A1c levels among Hispanic patients with diabetes enrolled in the Amigos en Salud(TM) (“Friends in Health”) program. The program uses trained lay community health workers (CHWs) to provide a comprehensive health education curriculum developed by Pfizer Health Solutions (PHS) and Gateway Community Health Center in Laredo, Texas, in collaboration with the Pfizer Foundation.

Eliminating health disparities has specific implications for the approximately two million Hispanic Americans suffering from diabetes. According to Healthy People 2010, comprehensive, nationwide health promotion objectives instituted by the Department of Health and Human Services (DHHS) in 2000, Hispanics with diabetes are less likely than Caucasians to receive diabetes education (34 percent vs. 46 percent), receive appropriate tests/referrals such as annual eye exams (38 percent vs. 49 percent), and self-monitor glucose on a daily basis (36 percent vs. 43 percent).

“In certain regions of the country, such as Laredo, specific community groups have economic and cultural differences that create barriers to receiving the best diabetes care possible,” said Angela Camilleri, MPH, MA, PHS. “Our goal through Amigos en Salud is to support through community health centers in the United States to reduce health disparities using a patient-centered and culturally-appropriate approach.”

The program was implemented in Laredo, Texas, a community in Webb County, where the population is 95 percent Hispanic and approximately 35 percent lack health insurance and fall below the poverty level.

Preliminary Study Results

The Gateway Amigos en Salud program results showed improved clinical and behavioral patient outcomes by integrating Hispanic community health workers called “promotores,” into the healthcare delivery system that typically includes a physician and nurse. The role of the community health worker is to provide culturally-appropriate self-management education to patients with diabetes and their families, facilitate classes and support groups, and help connect patients to the healthcare system and community resources.

A total of 508 participants enrolled in the program were randomized into the CHW intervention group or a control group receiving standard care. Preliminary results from 152 participants in the study showed that daily glucose monitoring significantly increased by 29 percent and mean A1c (glycated hemoglobin or HbA1c), a measure for monitoring diabetes, significantly decreased among patients in the CHW group, but not in the control group.

“These results demonstrate that motivated patients can play an active role in managing their diabetes,” said Lourdes Rangel, Director of Special Services, Gateway Community Health Center. “The Amigos program provides Hispanic patients with diabetes personalized care and education to encourage them to take a more active role in their own health.”

Patients who qualified for the study were also screened for depression, which is very common yet not often recognized in the Hispanic community. Those patients reporting depression symptoms on a standard patient questionnaire received additional intervention and follow-up by the CHWs.

Depression scores in the CHW intervention group improved by 53 percent, indicating a significant reduction in severity, while depression scores worsened by 16 percent over time in the control group.

“Many Hispanic patients experience depressive symptoms — anxiety, helplessness and loss of interest in normal activities — when diagnosed with diabetes, which can add a barrier to diabetes care,” said Rangel. “This Amigos program showed that individualized support not only improves diabetes self-management care, but also helps patients who suffer from depression.”